HomeMy WebLinkAboutIMPV-07-2022-175684.TIF G)
catawba county
public health
VOLUNTARY RELINQUISHMENT OF ADMINISTRATIVE APPEAL RIGHTS
Date prepared: 1/20/2023
Owner(s): algjandr..Anaya
Mailing Address: 1592 Farmington Hills Dr
Conover, NC 28613
Property location/site legal description: 3166 Tim Ct, Newton
PIN: 366903129984
Improvement Permit(IP) —1MPV-07-2027-175584_ Date Issued 7/14/2022
Authorization to Construct(AC) Date Issued
I.4I ,voluntarily relinquish my rights to pursue a formal appeal through the North
(print full n me)
Carolina Office of Administrative Hearings pursuant to NC General Statute 130A-24 and 150E-23 and all other applicable provisions of Chapter 1509
for the above referenced permit(s)(which includes the IPs and ACs)in order for the authorized agent/local health department to issue the
applicable permit(new IP and/or AC)for the site. I understand by completing this form that the permit(s)for a
Mg—25%Rrdurtion
(System description)
will be revoked immediately by the authorized agent/local health department.
I understand that the local health department's revocation of a permit can be appealed to the North Carolina Office of Administrative Hearings within
30 days of the revocation pursuant to the North Carolina Administrative Procedure Act. I understand that in order for the local health department to
Issue another IP and AC that the current IP and AC must be revoked. I understand that the local health department's revocation of an IP or CA is not
effective until 30 days from the revocation or,if the revocation Is appealed,at the time that the Office of Administrative Hearings Issues a final
decision. I understand that by signing this form and relinquishing my right to appeal the permit revocation at the Office of Administrative Hearings
that the local health department's permit revocation will become effective immediately. I understand and agree that the revocation of a permit that
takes effect immediately is in my best interest. I understand that by signing this form that I agree that I do not want to appeal the permit revocation.
I understand that I am not required to relinquish my appeal rights but that this is an option available to me so I do not have to wait 30 days for the
revocation of the permit to take effect.
__ai;_rmiAY:ao4t____________
Signature of Property Owner:
Date Signed: grji102 3
NCDHHS/DPH/E1-15/OSwP Revised May 2015
catawbacountync.gov
Environmental Health
Cctcwhc County Government (enter
25 Government Driae I PO Box 389 I Newton NC 28658 1828.465.8170
MAKING. LIVING. BETTER.
( )
catawba county
public health
January 20, 2023
Alejandro Anaya
1592 Farmington Hills Dr
Conover, NC 28613
Subject: Notice of Intent to REVOKE the Improvement Permit for 3166 Tim Ct, Newton
PIN 366903129484 Catawba County Permit IMPV-07-2022-175684
Dear Alejandro Anaya:
The Environmental Health Division of Catawba County Public Health intends to revoke your
Improvement Permit 30 days from the date of this notice.
If the permit is revoked,you must apply for a new Improvement Permit (IP) and meet the requirements
of the current laws and rules necessary to obtain a new IP.
You have a right to an informal review of this decision.You may request an informal review by the
environmental health supervisor at the local health department. You may also request an informal
review by the NC Department of Health and Human Services Regional Soil Scientist. A request for
informal review must be made in writing to the local health department.
You also have a right to a formal appeal of this decision. To pursue a formal appeal, you must file a
petition for a contested case hearing with the Office of Administrative Hearings 1711 New Hope Rd,
Raleigh, NC 27609. You may write the Office of Administrative Hearings,call the office at(984) 236-
1850 or get a copy of the petition form from the OAH web site at http://www.oah.nc.gov . The petition
for a contested case hearing must be filed in accordance with the provision of North Carolina General
Statutes 130A-24 and 150E-23 and all other applicable provisions of Chapter 150B. North Carolina
General Statute 130A-335 (g) provides that your hearing would be held in the county where your
property is located.
catawbacountync.gov
Environmental Health
Ccicwbc County Government Center
25 Government Drive I PO Box 389 I Newton NC 28658 1828.465.8270
MAKING. LIVING. BETTER.
If you wish to pursue a formal appeal, you must file the petition form with the Office of Administrative
Hearings WITHIN 30 DAYS OF THE DATE OF THIS LETTER. The date of this letter is 1/20/2023. Meeting
the 30-day deadline is critical to your formal appeal.
If you file a petition for a contested case hearing with the Office of Administrative Hearings,you are
required by law(NC General Statute 150E-23)to serve a copy of your petition on the Office of General
Counsel, NC Department of Health and Human Services, 2001 Mail Service Center, Raleigh, NC 27699-
2001.
Res ectfully, Dec,., r
/ Gie4.+}
can Evans, REHS
Environmental Health Specialist
Catawba County Public Health
•
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' �13% a CA'1'AWBA COUNT CaseA WIMPV-07-2022-175684 •
.1:�° i Public Health Department Subdivision BARRINGER OODS'PH 2
di4 ED Environmental Health Division PIN# 366903129484
• PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 29
Site Address: 3166 TIM CT, NEWTON NC 28658 •
Name on Permit: ALEJANDRO MARTINEZ ANAYA
' Property Size: Acres 3.05
Directions: NC-16, left onto Balls Creek Rd, left onto Cordia Circle, left onto Tim Ct, lot is at the end of the road
Owner/Authorized Representative Acknowledgement of Permit Receipt
A I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service EHPR-05-2022-40918, by the following method(s):
_ Received in Person
/ Facsimile Transmittal (Return form with signature required)
./f- Electronic Image Transmittal/E-mail (Return receipt required)
_ As the property owner or authorized representative I have reviewed and understand the specific conditions
of the permit issued, and further understand that all applicable regulatory requirements specified under the
North Carolina Laws and Rules for Sewage Treatment and Disposal Systems (15A NCAC 18A.1900), ,
and/or Well Construction Standards (I5A NCAC 2C .0100), shall apply to the issuance of this permit and
the construction of the wastewater system and/or water supply well permitted.
Permit Issue Date: 07/14/2022
Owner/Authorized Representative Signature
Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature Date/Tim;e7h /'Z4
/
Method: Fax �/ Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
We wantt tto hear from yo&lease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EfiCusttomerService
•
>unannti 07/14/2022 08:32 ' ,